Form Mo 580-2624 - Nursing Home Surety Bond Page 2
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1
2NURSING HOME SURETY BOND
INSTRUCTIONS
Missouri law, Section 198.096, RSMo, requires all operators of facilities who hold in trust personal funds of residents
as provided by Section 198.090, RSMo, to obtain and file a Nursing Home Surety Bond or a Noncancelable Escrow
Agreement with the Missouri Department of Health and Senior Services.
1. A surety bond must be in a form approved by the Missouri Department of Health and Senior Services. (Section
for LongTerm Care Regulation will furnish forms.)
2. A surety bond must be issued by an insurance company licensed for bonding with the State of Missouri.
3. A surety bond must have a number for reference.
4. A surety bond must bear an effective date.
5. A surety bond must be signed by the attorneyinfact and a person having authority to sign for the entity.
6. A surety bond must be accompanied by a power of attorney letter.
7. A surety bond must be an original; it may not be a copy.
8. The principal as indicated on the bond must be identical to the licensed operator as appears on the Missouri
Department of Health and Senior Services license to operate a longterm care facility and as registered with the
Missouri Office of Secretary of State.
9. A surety bond must be at least $1,000.
10. A surety bond may cover more than one licensed facility operated by the same operator if the facility is a multi
licensed facility on the same premises. You must indicate what licensed levels the bond is covering.
11. A surety bond may cover other licensed facilities operated by the same operator which are at other locations in
Missouri provided the bond specifies the amount of coverage provided for each individual facility and the
coverage for each facility is a minimum of $1,000.
12. If a surety bond includes a provision allowing the surety to cancel after notice, the Missouri Department of Health
and Senior Services must be notified at least sixty (60) days prior to cancellation. The notice must be sent to:
ATTENTION: LICENSURE AND CERTIFICATION UNIT
SECTION FOR LONGTERM CARE REGULATION
MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES
920 WILDWOOD, P.O. BOX 570
JEFFERSON CITY, MO 651020570
All surety bonds must be sent to the above address for approval.
All forms may be found on our website at:
MO 5802624 (109)
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DA638
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